Keywords: generalized
anxiety disorder; panic disorder; social anxiety disorder; posttraumatic stress disorder; obsessive compulsive disorder; benzodiazepine;
antidepressantAuthor affiliations: Department
of Psychiatry, Neurobiology, Pharmacology,and Biotechnology, University of Pisa,
Pisa, ItalyCorresponding author: Stefano Pini, MD, Department of Psychiatry,Neurobiology, Pharmacology, and Biotechnology,
University of Pisa, Pisa, Italy(e-mail: s.pini@psico.med.unipi.it)Exposure of the general population
to a 1:4 lifetime risk ofdisabling anxiety has inspired generations
of fundamentaland clinical psychopharmacologists,
from the era of theearliest benzodiazepines (BZ) to that
of the selective sero-tonin reuptake inhibitors (SSRIs)
and related compounds,eg, the serotonin and norepinephrine
reuptake inhibitors(SNRIs). This comprehensive practical
review summarizescurrent therapeutic research across
the spectrum of indi-vidual disorders: generalized anxiety
disorder (GAD), panicdisorder (PD) and agoraphobia (social
anxiety disorder),compulsive disorder (OCD), phobic disorder (includingsocial phobia), and posttraumatic
stress disorder (PTSD).Specific diagnosis is a precondition
to successful therapy:despite substantial overlap, each
disorder responds pref-erentially to specific pharmacotherapy.
Comorbidity withdepression is common; hence the success
of the SSRIs,which were originally designed to treat depression.Assessment (multidomain measures versus
individual endpoints) remains problematic, as—frequently—do
efficacyand tolerability. The ideal anxiolytic
remains the Holy Grailof worldwide psychopharmacologic research.Dialogues Clin Neurosci.
2002;4:271-285.nxiety disorders are the most common andamong the most disabling of mental disorders in adultsand adolescents.1 Although many are highly circum-scribed fears of mild-to-moderate severity, it
has beenestimated by the Epidemiological Catchment Area(ECA) study2 that
approximately one quarter of peoplewill experience severe symptoms, disability, and
handicapas a consequence of anxiety disorders at some time dur-ing their lifetime.These disorders are associated with
sig-nificant morbidity3 and
increased mortality, probably asa consequence of increased suicide rates among suffer-ers.The direct and indirect costs to the health service
andeconomy are considerable.Although persons who sufferfrom anxiety disorders are high consumers of all types
ofhealth services, only a minority receive specific
help.4The spectrum of anxiety disorders includes generalizedanxiety disorder (GAD), panic disorder (PD) and
ago-raphobia, obsessive-compulsive disorder (OCD), phobicdisorder (including social phobia), and posttraumaticstress disorder (PTSD). With the discovery of new
psy-chotropic medications, specific diagnosis within
this spec-trum is essential because each of these disordersresponds to specific pharmacotherapy. The approach
toanxiety should also recognize that anxiety and depres-sion are often comorbid conditions.Selective serotonin reuptake inhibitors (SSRIs), whichwere designed to treat depression, are also effective
formany anxiety disorders. They have revolutionized
thetreatment of anxiety, replacing chronic use of
benzodi-azepines (BZs). SSRIs are effective for OCD, PDs,P h a r m a c o l o g i c a l a s p e c t s2 7 1Psychopharmacology of anxiety disordersGiovanni B. Cassano, MD; Nicolò Baldini
Rossi, MD; Stefano Pini, MDA
Alert